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Beware the ides of March

Beware the ides of March

(Scene one.) Julian English reminds readers that the ides of March have come but not gone...

First GDP: Peace, ho! Let us hear himSecond GDP: Yet form thee not a queueAnthony: Friends, colleagues and performers, lend me your ears; I come to bury nGDS, not to praise it. The mistakes of PCT managers live after them; the good is oft interred in policy. So let it be with nGDS. It is an honourable contract.

For three years dentists have a fantastic opportunity to convert while being paid for contract values. No longer will they have to run patients cattle-like through their surgeries in order to chalk up enough items of service. Think of the business acumen and mastery of small print that has made UK dentistry the most efficient and cost-effective in the industrialised West. nGDS is a chance of a lifetime for the profession to redefine treatment plans and judge what is and what is not necessary to secure reasonable dental health. For dentists who find themselves repeatedly asking: ‘Is this type of intervention really necessary’, the opportunities of nMixing are unlimited. With private patients of long standing, where there is a reciprocity of trust, there is no reason why they cannot pick up the odd 12 UDAs for essential treatment, where circumstances permit. As Kevin Lewis defined it in his recent Papillon Seminars, acceptance of the contract is a three-year soft landing, the aim of which must be to put yourself in a position where you can completely distance yourself from any PCT control.

It is an honourable contract.Be humbled. Historically DoH officials have always had an ambivalent attitude to High Street dentists. Their repeated failures to draw up statutory instruments of control are legion. Dental services were never a priority. PCTs and Health Authorities before them never did teeth. What do dental service project managers know about the dynamics of the dentist/patient relationship? The only effective policing authority was the DPB, and now it is to be abolished. RDOs for the second time in their history are being marginalised.

But it is an honourable contract. The BDA welcomes it.

Dentists remain the only health professionals to truly retain independent contractor status. GPs sold their souls a long time ago and hospital consultants have had their wings trimmed for over 20 years. The freedoms dentists have are unique and attract envy from family doctors. Executive Councils, FPCs, FHSAs and HAs have all attempted the carrot and stick approach. They all failed. Now PCT managers are trying. Pity them. Many will have nervous breakdowns in the next two weeks, squeezed as they are between the Director of Access in Quarry House and practitioners on their patch. They have about as much discretion in local commissioning as Inland Revenue inspectors have over taxes. In three years, these ex-SRN managers will have either moved on or been sacked.

But it is an honourable contract.

It is honourable because it was written by Department lawyers and officials. It is being offered in good faith and with the same level of trust as in 1948 and 1990. The words of the contract mean exactly what they are meant to mean. Both performers and providers should be eternally grateful for the cogent and precise manner of their drafting. After all, it will be the same words that the dento-legal secretaries of the protection organisations will be using for the inevitable threat of variation or termination. If the words say that inserting pins in a chairside-fabricated cold cure acrylic crown on a patient, at a cost of 12 UDAs, secures dental health, than everything will be fine. The contract says nothing about maintaining dental health. It is an honourable contract.